From close-up experience with the Federal employees health-care plan, and the insurance industry in general, I can tell you that Wyden significantly misrepresents how both work, and therefore his plan. Furthermore, pretty clear the chattering class of progressives amongst us who make their nut flapping their gums and tapping their keyboards don't really understanding the difference. I'll try to explain with some simplifications to make the explanation accessible. I'm assuming folks here have the maturity to not jump on possible errors that arise as a result of that simplification to try to distract from the substance.

The Federal employees plan has only a superficial resemblance to Wyden's plan. In the Federal plan, the Federal government is both the employer who makes the "employer" contribution and and the insurer who writes the checks. What you think of as the funds to pay doctors, hospitals, etc. for the set of very good basic coverages are primarily derived from the treasury, and from employee contribution for optional coverages such as long-term nursing coverage.

Insureds do deal with private companies such as Blue Cross when they have a claim. But those companies are simply administrators of the plan. They do not set the benefits, nor the criteria for deciding what to pay. The checks are not cut by the administrator, nor are the guidelines for coverage decisions actually initiated by the administrator as with private insurance. This sets up a very different dynamic in terms of where the private companies derive their profits from what Wyden is proposing.

The fact that Wyden is trying to pull a fast one is easily understood by juxtaposing these two comments on his own website:

The Healthy Americans Act creates a system of tax benefits and premium reductions that will ensure every American can afford a high-quality, private health plan that is comparable to what Members of Congress enjoy now.

Every time an individual interacts with state, local and federal government—registering their car, enrolling their children in school, applying for a driver’s license or paying their taxes—they can be required to verify their enrollment in a private health insurance plan.

As noted, Members of Congress do not have a private health insurance plan. They have a federal plan whose adminstration is contracted out to private companies. The big difference is where the profit (and profit motive) lies in the Federal employees system and Wyden's deceitful plan. As well as the difference in the costs to us of underwriting those plans.

If one needs any further proof that Wyden is trying to deceive, I just heard his rather slimy performance on Thom Hartmann (the end of the 8:00 hour, 12/15/2006).

First, he doesn't make it clear the critical distinctions just described between the insurance coverage he enjoys as a Senator and this plan. More importantly, he then went on to attack those who have advocated that we just have Medicare for all (which I do as a true progressive.) In fact, the problems with Medicare that have made the most news lately - the private prescription plans - are very similar to what Wyden has proposed here.

As part of his attack on Medicare, Wyden also threw in some gratuitous comments about the political reality of how the insurance companies aren't going away and how they employ a lot of people who would be out of work if we had Medicare for all. The honest answer to that is quite simple: If the core Medicare plan (part A, part B) were revamped into Medicare-for-all along the lines of the actual Federal employees health care plan, there would be a new industry and jobs for current insurance company employees as administrator of the Medicare system.

Ron is pulling a fast one here. Too bad a lot of the faux progressives here don't have a lot of real life experience to know it.

politicallogic,

i'm not an expert on health care, but as a congressional staffer, i'm pretty sure that the FEHB plan is now (it may not have been before) run through private insurance, not just administeres by them. that is, i choose from a range of insurance companies who all offer different benefits at different employeee contribution levels.

I am another federal employee covered under FEHB. I guess I have trouble parsing the fine distinction between administering the plan and actually running the plan. I can tell you that checks are indeed cut by the plan I have chosen (Blue Cross in my case). However, I believe that politicallogic is fundamentally correct in a very important way: the employer contribution is coming out of the US Treasury, and thus Uncle Sam is deciding what the level of coverage will be. I have always been a bit shocked about what the federal employee Blue Cross plan fails to cover: regular eye exams, for example, unless one can demonstrate that one has some sort of ocular disease. My family and I had better, more comprehensive coverage when I was a Washington state employee than now as a federal employee.

In any case, the federal employee health benefit system is not a for-profit scheme.

Every year in the fall I get asked to choose between various plans with varying costs, as noted by congressional staffer but for all practical purposes, the choice comes down to Blue Cross/Blue Shield of Oregon versus Kaiser.

The Blue Cross plan administration for federal employees seems to operate primarily as a gatekeeper. BC seems to find any excuse to decide they need to "investigate" a claim, request "more information", and so on. I've seen this over and over again in regards to claims for my spoouse, who has various chronic medical problems and is certainly not a "profit center".

If Wyden's plan does not bring us to a single payer system, it at least is a step in the right direction. I would do everything in my power to cause the country to move to a single payer system based on universal coverage under Medicare A & B. But, as others have said, with the millions of jobs and billions of dollars of profits from private health care, it would literally take a revolution (the kind with guns and bombs)to dislodge the private insurance system from its choke-hold on the US health care system. Therefore, small steps in the right direction are probably the only realistic alternative we actually have. Of course, we could oppose all changes to the existing system and wait and hope that the entire private system collapses under its own weight, but that might be very painful for a lot of people, both insured and uninsured.

kari,

if for one do not have "some ideological affinity for one financing model over another", nor do require a single-payer system. what i do require is a system that is not a huge hand out to insurance companies, without requiring real reform.

at the very least, if we are going to be handing billions of tax-payer money to insurance companies, who have a proven record of making money by cleverly denying care, then let's require them to put a citizens group on their board so we can review CEO salaries, and such.

I'm with peter. Having recently had arthroscopic knee surgery, I am now having to deal with an insurance company--Assurant, of all names--that is trying to deny paying its share of the fees (which after deductibles amounts to about half the cost). It appears that a signmificant portion of health care costs goes to a bureaucracy whose purpose is to get someone else to pay the bill.

Why don't we go to a single-payer plan and then give the insurance companies a severance package? Come up with a big nice round figure to pay the insurance companies to get out of the health insurance racket, say over five years. This may sound like a boondoggle, but if it would make the single payer plan political feasible, I would also bet it would cost the average citizen less in the long run.

It may be worth pointing out that insurance companies are not the only group getting rich under the current health care system. In my day job I have once or twice had the opportunity to see the compensation packages of some of the executives of certain local "non-profit" hospitals. While the hospital corporations themselves may qualify as "non-profits", I can assure you that upper management receives some of the biggest compensation packages I have ever seen outside of Wall Street. So when you talk about opposition to change, don't just talk about insurers.

What's that? I've heard of this so-called idea of 'health-care' but I have never experienced it. I thought it was normal to pay doctors $500 to visit for a sore throat. Am I missing something?

As a nurse who has worked jobs where 80% of my time was spent calling insurance companies instead of providing patient care, I can't tell you how despicable these corporate "plans" are to me. The insurance industry and the pharmaceutical industry must be removed from the equation.

I heartily recommend the "quote-of-the-day" by Dr. Don McCann, for analysis of various health care schemes: http://two.pairlist.net/mailman/listinfo/quote-of-the-day

I agree that we need a revolution, but it doesn't have to come with bombs.

And here is part of Dr. McCanne's comment about the Wyden sell-out proposal:

The Lewin report contends that price competition between health
plans, and greater administrative efficiencies will lower costs
significantly. If the consolidated efforts of employers have been
unable to control costs and waste, how can individual purchasers ever
expect to exert market pressures to achieve these efficiencies?

The last section of the Act list many other potential sources of cost
savings. Reading the list, the savings potential for many is simple
rhetoric, not supported by fact. Some of them would actually increase
costs. The Act excludes more effective cost measures such as those of
the single payer model.

The point is that costs will continue to increase and wage earners
will have to face those costs alone. Employers will have divorced
themselves from the problem and will not make an exception for health
care anymore than they already do for food, housing and transportation.

Wyden's plan falls apart since it depends on price competition of
health plans, which in turn depends on shifting more unaffordable
costs directly to those who need care.

Guess we ought to be counting on Joe Lieberman to line up to cut a sweetheart deal for his insurance friends....

Sal-- I'm glad you approach this legislation with lots of questions... we all should. But the whole thing about a 30K deductible is nowhere in Wyden's plan, so stop bringing it up. The baseline plan that is used as the benchmark for Wyden's estimates isn't even close to that much. Feel free to actually read the bill (or at least the support docs) before you spread misinformation: http://www.wyden.senate.gov/. There's plenty to like and not like about this bill but let's stick to what Wyden actually proposed when we're discussing its merits and problems.

lin qiao correctly made the point in much fewer words that I was I trying to make in informal terms. I'll expand a bit since it seems folks have degenerated into flogging Sal over a particular detail.

First, the Federal Employees Health Benefit plan is what has been termed "managed competition" (rather than "managed care"). That reflects the first hand experience lin qiao was relating. The federal governments specifies the coverages it will pay for, and in effect the "carriers" simply say how much they want on top of the amount they will pass through to a provider to negotiate the transaction. Furthermore, when I said the federal government "cuts the check", that was shorthand for saying that Blue Cross essentially simply writes a check on a company account in which at least 75% of the costs of generating the deposits to the account are from the U.S. Treasury.

Second, "Blue Cross" is not a company. It is kind of a hybrid between a trade association of private companies and a franchise operation that those private companies pay for the right to be called a "Blue Cross" company. In some states, "Blue Cross" (companies) also administer Medicare. Blue Cross companies are just some of the companies federal employees can choose under the FEHB program to handle the logistics of making sure providers get paid federal funds to provide health care services to Federal employees.

Third, the choice Congressional Staffer makes in choosing who will do that logistics job is quite different than you or I, or our employer if we are lucky, makes right now in an insurance company. It is also quite different from the choice you or I would make under the Wyden plan. In the case of the FEHB, the carrier essentially has no business risk because of the size of the pool, who pays the large majority of the premiums, and the value of the premiums compared to the payouts for services. In addition, the carrier must offer plans that conform to the requirements set by FEHB. For you and I, the insurance company has a very different risk profile, and offers benefits they determine based on their private business considerations and profit objectives. We have to choose between whatever insurance companies offer at whatever price they offer it.

Fourth, Wydens' primary goal seems to be minimizing the risk to the industry on the theory that this will induce them to almost altruistically make it possible for everyone to become insured. As best I can tell he would do this by increasing the size of the pool, which he would in turn do by requiring everyone to carry insurance. He leaves it up to us to negotiate the contractual relationship with private carriers, and to figure out how the heck to pay for it. (It is always interesting to me how the faux progressives amongst us in Oregon always go for paternalistic authoritarian solutions like this.)

Fifth, single payer alternatives like Conyers-Dingell's Medicare-For-All, similarly reduce costs by increasing the size of the pool. However, they also indirectly provide us leverage by increasing our buying leverage. In direct contrast to Wyden's plan where we individually have to negotiate with carriers, the carriers have to negotiate whatever contract they can with us collectively. It should be clear which is the better position to be in as a forced buyer.

Sixth, Ezra Klein's really is offering a defense of the industry in the form of a false and refutable argument about the possible. As just one example, we learned from the Depression that when the people get agitated enough that business interests are faced with the choice of something or nothing, most things are at least negotiable. I'd say the current economic realities and health care crisis confronting most working in these times has reached the point that insurance companies really are facing the choice of having their very existence made uncertain, or acting as administrators of a single-payer plan --- as the Blue Cross companies do right now. I'm confident that "Medicare-For-All" is an easy enough sell with a large enough majority of the population to be an attractive political proposition if we don't have false progressives like Wyden and Klein selling us out and trying to deceive us.

Finally, Kari is just flat out wrong in arguing that The plan itself is the same very generous plan that members of congress have given themselves. (Reading Kari's posts on this blog, I chose to be generous and believe he doesn't really understand why his argument is wrong rather than being outright deceptive). The benefits be comparable, but there is no reason that the full costs to each individual will be the same, compared to the costs to each federal employee under the FEHB, because the two plans are paid for and administered quite differently. I have not yet seen any analysis which compares the actual full costs to each insured individual of the Wyden plan compared to the FEHB system that properly takes into account the buying power of a single-payer system like the FEHB program.

ok, i have read the whole text of the bill now. i was too hard on Wyden earlier, this bill is wonktastically, DLC-licious. the pieces fit together like a jigzaw puzzle. however, this is not the kind of thing that excites most people. wyden's approach is not surprising to me--it's what i expect--however, he is also attempting a grassroots component, building support from the ground-up, and i just don't see this proposal succeeding in that realm.

i'd say it is a net step in the right direction (2 forward, 1 back). if he really wants to move things in the right direction, then he should include in this bill the right to buy into Medicare or the FEHB plan. let the insurance companies compete against a truly efficient health insurer. if they can't compete they can't compete--let's let the market decide.

either way, i expect bush to veto it.

I'm not at all an expert in this, but ... as someone who has a family member with a serious medical condition that has significantly deteriorated over the last 3 years, I can tell you the current system is broken. The insurance companies are run by accountants (primary care providers are called: cost centers!) and medical care professionals are (nearly) as frustrated as I am. Until we take the obscene profits out of this 'industry', it will only worsen, IMO. Bill Frist probably wouldn't agree with me, though.

OK, I don't know many people with $4000 laying around and I'm middle class. So, what if you don't have the $4000? Are you denied care, can they take away your house? Do the collectors come after you?

I am a bill collector. I have collected debt of every legal description, and for the first 18 years of my now 23 years was in the field of medical collections for the most part.

I won't collect of another medical provider again!

Acronyms, HMO's, PPO's, and the assortment of private insurance companies, and medical providers forming the very socialist concept of a collective system of medical providers owned and operated on the assumption that a cost/benefit/profit formula should be a foremost consideration when administering health care. If you think the evolution of healthcare delivery in America has changed for any other reason, and that the idea was to be able to deliver more care to more patients by holding down costs, you are either a rich doctor, or an insurance executive, or just so healthy or rich not to care.

When I lived in Las Vegas until we moved here in ’99, I was working for the top agency in the state that had the largest inventory of assignments of medical providers in the state, and as you might imagine we received many out of state patient accounts. I had been hired to work medical assignments that were for the most part disputed claims to the patient’s insurance. I was exposed to Oregon’s evolution of coverage as it related to out of area services, and had many opportunities to argue the minutia of these plans with their legal counsel as well as claims adjusters who’s main function was to detract, or discourage payment whenever the opportunity presented itself. This is a practice that all the insurance companies were deploying to one extent or another.

The point could be explained in it’s evolution over a 25 year period as Medicare/Champus standardize the claim forms for hospitals, and then all medical providers. These codings that were used in concert with these forms made the previously simple process of a claim, deliciously complicated for the medical providers, and patients to argue their claims to be paid, and eventually to ever receive the services at all!!

That’s right, the process of standardizing the claims, though effective in saving money for Medicare/Champus patients, was perverted over time by the private sector to eventually cast the sickest, and most costly patients out of their insurance rolls, and to deprive services with patients still in the system. The medical providers have less, and less to say about how to treat patients, and the profit motive has more, and more to do with what kind of care a patient will receive, whether the procedures are needed, or wanted to begin with.

'Capitation' became the final straw for me, as one month years ago I was part of a crew of specialists asked to work a huge number of unpaid claims over $2500.00. As we were to find out after rebilling hundreds of thousands of dollars in claims,and we waited in great anticipation for a flood of checks from insurance companies that were suspiciously easy to process that showed up in the form of a cancelled check of $0.00!! The insurance company, nor the medical providers we had been collecting for many years didn’t think it was important to tell us that they had been paid in advance for their services in a contractual agreement that had the insurance company deploy a formula of how many patients they should expect to see, and paid them 3 months in advance and that we were collecting the excess that the insurance company was not obligated to pay!!

This should not have been a big surprise, as they were evolving to this but, I would point out that the whole motive to provide care has been perverted to a profit motive, and little else. A Medicare/Champus single universal payer system is the only way in our form of democracy/free enterprise to deliver effective health care to everyone, instead of whomever can afford to be insured, or better put whom the insurance companies deem as affordable patients.

Getting away from employer-based health insurance is a very good thing. That was yet another stupid consequence of government action during WWII. Imagine having your auto insurance thru your employer. You get laid off or fired, and then can't legally drive around to interviews etc. Dumb, dumb, dumb.

Note that my support for getting away from employer-based insurance is all I'll say on this right now.

Bob T

OK, I don't know many people with $4000 laying around and I'm middle class. So, what if you don't have the $4000? Are you denied care, can they take away your house? Do the collectors come after you?

You don't plunk down $4,000 right up front. It's meant to represent cumulative costs over the calendar year, and your out of pocket expenses shall not exceed that amount. People with insurance (as one would be under this plan) would be billed after the visit/procedure/etc. Most providers have payment plans.

Torrid Joe:

The maintenance of private insurers as the primary deliverers of care is the big sticking point, it seems.

Bob Tiernan:

Nothing really wrong with private insurers per se, but problems arise when they get a captive market (like with mandated auto insurance) thru government legislation.

Bob Tiernan

But what if I break my arm and it costs $4000 to reset, cast, etc. Where one emergency visit costs $4000? What if I earn, say $23,000 a year at a nice college job in an expensive town where you come out, say, with $18,000 a year after taxes, medicare, etc. Your rent in a crappy single room apartment is $800 per month and your bus pass, food, electricity, clothes are, say $400 a month. That is $14,400 per year. That barely leaves $4000 for medical assuming you own no car, have no rental insurance, eat mac n cheese, and have no children, pets, need for entertainment, need for internet, or have a single hobby. Is that realistic?

You don't plunk down $4,000 right up front. It's meant to represent cumulative costs over the calendar year, and your out of pocket expenses shall not exceed that amount. People with insurance (as one would be under this plan) would be billed after the visit/procedure/etc. Most providers have payment plans.

Unfortunately, the reality is that it is extremely rare to find insurance coverage that covers everything 100%. And also, unfortunately, health care is expensive. I have seen Medicare mentioned as a preferred model for universal health care (being single-payer and such), but a plan modeled after Medicare would leave you with potentially higher out of pocket costs because it doesn't place a cap on how much a patient has to pay. The plan being proposed at least places caps on how much you'll be spending.

Trying to come up with a plan for universal health insurance is meant to minimize the number of uninsured citizens. It's not meant to provide cost-free coverage. I verify people's health insurance for a living, and most insurance plans I see have lower benefits that what is being proposed.

Let me revise my statement - Medicare offers some caps in certain situations, but in others a patient is expected to pay 20% without any out of pocket limit.

You'd likely be at tens of thousands of dollars in delivered health care before you hit that $4000 in out-of-pocket.

Indeed. What the patient pays out of pockets is much less than what the plan will cover. The plan already pays 90%, so unless you have major surgery, you may not even be paying $4,000 out of pocket a year. And if you do, the total bill will have been exponentially higher.

Some insurance is better than none. And this level of coverage is better than most.

I read the debate over the proposal made by the Honorable Senator Ron Wyden, and I'm warmed by the process of hearing debate about the details of how much will be a deductible, and the principles of how we will change health care coverage through the existing insurance companies. I realize this debate will eventually reach the place it needs to reach, or the debate will end all together!

I first heard this debate in intelligible terms on the AM Radio in 1986 as I was hauling my sister’s belongings over the mountain in a U-Haul with those annoying governors on the motor; I had both feet standing on the accelerator as I was going over the mountains to LA from Las Vegas. It was a Sunday morning and no less the Howard Cossell was the speaker on the subject. The “Conference of Medical Providers in Crisis” was the subject of his conversation for nearly 2 hours as I was crawling up the mountain at 20 mph. I wondered how this near-do-well lawyer and bloviator would handle such a complex issue, and I remember vividly how enlightened he really was. I felt as though I was listening to a college professor discussing his dissertation. The timing of this program and conference occurred precisely when HMO’s and PPO’s exploded on the scene!!

HMO’s and PPO’s were offered up as solutions for a long term approach in dealing with what was then, and still is skyrocketing health care costs. The truth in the end is if we keep the insurance companies in the process of major health care delivery we are just handing greater control, and greater profits for the insurance companies, and equally less medical care delivery to fewer patients at the same skyrocketing costs!! We could debate the issue in great details, as the devil would agree is were the hell really exists, or we can step back and recognize the painfully consistent history of American Healthcare under the thumb of the insurance industry!!

Medicare/Champus was then and is still today the most cost effective method of administering medical services while not depriving the patient and doctor the freedom of providing unfettered health care!! The history is unmistakable, and yet we won’t even consider discussing it as it seems to smack of socialism, or the myth of anti-Americanism!!

This constant backslide on this issue makes the insurance companies more entrenched in the problem, and does nothing to solve what is now a serious, chronic national crisis that will eventually highlight the huge disparity between our socio-economic classes, and possibly political and social chaos!!

Happy Thoughts;

Dan Grady

Wyden, Kari, and other advocates have consistently sidestepped the problematic part of this plan in their selective presentation of benefits without discussing actual total cost to the individual. (By the way, the figures Kari cites are on page 5 of the "Cost and Coverage Estimates for the "Healthy Americans Act" report dated December-12-2006 downloaded by link in Kari's Dec 14, 2006 9:01:19 PM, not page 8.)

First one needs to recognize that the assumptions as Sheils et al state them in modelling the supposed cost of the plan to individuals:

We assume that the savings to employers would be passed-back to workers in the form of increases in wages. This reflects the HAA requirement that employers “cash-out” their benefits plans. It also reflects economic theory and research indicating that changes in employer benefits for health care are, in the long run, passed back to workers in the form of wages or some other form of compensation such as pensions or disability insurance.

is not really reflected in the law. The law would not require that such savings "be passed-back to workers in the form of wages" anywhere I can find. Instead, Title VI, Subtitle B, Sec. 611(a)(1) on page 96 provides that Subtitle C, Chapter 24 of the Internal Revenue Code would be amended to add Chapter24A, Subchapter A, Sec. 3411, paragraph (c)(1)(a) that requires employers to remit a portion of what they previously paid for employee healthcare premiums to the government.

Crucially, the amount of money an employer would actually would be proportional to what an employee made before this plan went into effect, not the actual amount the employer paid, or what the employer would have to pay under the plan, which ever is less (paragraph (c)(1)(B)(i) p. 99). It is debatable whether the numbers in Shiels et al cost analysis are realistic. Particularly when one takes into account that employers will have a legal fiduciary obligation to fight tooth-and-nail to have every tax aspect of this law that is unfavorable to them removed.

Second, there is another issue that we have a right to have addressed: The cost analysis is predicated on vaguely stated assumptions about required employer contributions. The law as written talks about required employer contributions for "full-time equivalent employees" (p. 96) and defines FTEEs about as one would hope (p. 105). That is, as the sum of all hours worked by full and part-time employees divided by 40. We all are familiar, however, with how employers historically have hired part-time employees to avoid providing insurance benefits (reducing the transition payments discussed above that might be expected, incidentally). The issue that Sheils et al don't address in any depth is how much people who can only get part-time work, and for whom the employer's contribution will represent a smaller portion of their individual total premium costs, will actually have to pay out-of-pocket after whatever subsidies they are entitled to.

Based on the virtually unfounded numbers and superficial discussion provided in the cost analysis, which is the only information that our senator has chosen to give us about his plan, there is no reason that I can see to believe that these people will actually be able to afford their mandatory contribution under his plan. Nor is there any reason to believe, until he realeases the full mathematical details and assumptions of the model Sheils' et al claim to have used, that the actual costs to anyone under this plan will even be close to their rosy estimates.

Long story short guys is that we make a SSI/Medicare contribution in every paycheck in America aside from independent contractors which have been finely defined by the IRS to the extent it makes employer/employee escape from such a contribution very difficult, and risky for those whom would attempt to game such a plan.

Let me help you with the formula that would be all inclusive of cost/benefit analysis, as well as any inequities that may arise in the course of implementing a universal medical care delivery plan.

It's called "POLITICAL WILL" for "SINCERITY IN GOVERNANCE."

When the painfully obvious solutions are in plain sight you can assure yourself that the argument being made about the minutia of a plan in great complexity is the argument intent on dismantling the solution for a status quo agenda! The solutions for such an enormously complex issue is often made complex as a subterfuge to change!

We have 30 years experience in cost controls, and claim processing that has been very sustainable with Medicare. The only reason Medicare faces a crisis is because it was raided by those whom don’t want the competition in the market place through their agents in the form of our own Republican Leadership as they raided the trust fund. I refer you to the above stated solution as a cure all to skepticism over the feasibility of such a strategy!

They have had their solutions implemented repeatedly when the issue of their solutions is brought to the fore. We as a nation have endured the constant “kicking of this can” down the road until we finally find ourselves in a place that makes putting this off a ridiculous argument, so let’s keep shedding light on their arguments for what they plainly are, ridiculous!!

Happy Thoughts;

Dan Grady

The law would not require that such savings "be passed-back to workers in the form of wages" anywhere I can find.

It's on page 98, line 13, of the legislation.

Kari, here is the text starting at page 98, line 10 in the PDF file linked at the "Stand Tall for America website":

http://www.standtallforamerica.com/cms/images/healthyamericansact.pdf

<font face="Times New Roman"> 98 ...... 10 (c) TRANSITION RATES 11 (1) TRANSITION RATE FOR EMPLOYERS PRE- 12 VIOUSLY PROVIDING HEALTH INSURANCE -- 13 (A) IN GENERAL - In the case of the first 14 and second calender years to which this section 15 applies, in the case of any employer who pro- 16 vided health insurance coverage for employees 17 on December 13, 2006, the employer share re- 18 sponsibility payment shall be, in lieu of the 19 amount determined under subsection (1), an 20 amount equal to --- 21 (i) 100 percent of the designated em- 22 ployee health insurance premium amount 23 of such employer, minus 24 (ii) the employee salary investment 25 amount. </font>

On page 99, the text goes on to discuss technical definitions of the 'Employee Adustment Amount' that is the amount the employer must remit to the government. This whole section is the amendment to the Internal Revenue Code starting on page 96 I cited previously:

The law would not require that such savings "be passed-back to workers in the form of wages" anywhere I can find. Instead, Title VI, Subtitle B, Sec. 611(a)(1) on page 96 provides that Subtitle C, Chapter 24 of the Internal Revenue Code would be amended to add Chapter24A, Subchapter A, Sec. 3411, paragraph (c)(1)(a) that requires employers to remit a portion of what they previously paid for employee healthcare premiums to the government.

Nowhere in this section does it provide a meaningful legal inducement for employers to behave in a way that unequivocally justifies Sheils et al argument that We assume that the savings to employers would be passed-back to workers in the form of increases in wages.

You also make the criticism:

You're free to disagree with the proposal, but let's not go slandering the Lewin Group. They're generally considered the gold-standard in unbiased, independent, nonpartisan fiscal analysis in the health care industry.

Slander is oral defamation. Defamation, in turn, is a claim which can harm the reputation of the subject of the claim. However, factual statements which are true, even if the truth of which diminishes the subject of the claim, are not defamation (ask RW, he's a lawyer). The bar is even higher when it comes to political debate. The quote you cite Based on the virtually unfounded numbers and superficial discussion provided in the cost analysis is true.

They provide no independently verifiable basis or data for their cost claims. Specifically, their discussion presents numerical conclusions with no presentation of the actual mathematics used to derive those conclusions from the data and their questionable assumptions. In fact, my comment notes Nor is there any reason to believe, until he realeases (sic) the full mathematical details and assumptions of the model Sheils' et al claim to have used, that the actual costs to anyone under this plan will even be close to their rosy estimate. This is not even remotely close to your accusation. Furthermore, it is a legitimate observation why extreme skepticism of Sheils' et al analysis, and this legislation, is justified.

As an educational aside, however, you clearly have made an implied accusation of defamation. That actually is much closer to being defamation.

Another troubling claim/assumption by Sheils et al which figures in their analysis and conclusions is found on page 10:

This approach greatly reduces the administrative costs now incurred by insurers under the current system. Insurance broker and agent fees for health insurance would be eliminated, as would medical underwriting costs. It also reduces premium collection costs by obtaining payment from a single source (i.e., the HHA) for all of those that they insure. ... The HHAs would effectively organize regional populations into a large single group for each insurer, each of which is likely to include 10,000 or more members. Thus, by using the HHAs as a single source for enrollment and premium payments, insurers can be expected to cover these populations at costs comparable to those of existing large groups.

In plain English, they are saying this plan effectively is a single-payer plan. But it is a single-payer plan for insurance premiums to insurance companies, enforced by the government as collection agency, not a single-payer plan for medical services. (Why is it that NW "progressives" invariably embrace paternalistic, authoritarian solutions rather than genuine progressive solutions which put the interests and rights of the people ahead of powerful special interests?)

There is not buying power leverage here because the individual citizen is forced to make a purchase, but the government acts as the actual payer to the insurance companies as sellers (who have great lobbyists as this plan proves.) In a single-payer-for-service plan, sellers of services have a limited number of buyers, so that the our collective buying power gives us leverage.

If anyone has any doubt what RW and the other creators of this plan have in mind, they explicitly state that on page 13:

The program includes features designed to make people more aware of their spending for health care and to create incentives for consumers to seek-out lower-cost health coverage. One of these features is that employer spending for health benefits converted to wages so that the worker faces the full cost of health insurance. This would give families the opportunity to retain some of this cash for other purposes by purchasing a less costly health plan. Also, families must pay the full amount of the added cost of selecting a higher cost health plan as further incentive to conserve on spending.

This is almost exactly what all those regressive right-wingers who don't believe equitable and accessible health care should be a right have been advocating ever since the first attempt at fixing our health care system in the 1990s. That is, the goal is to get people to make decisions about foregoing health care, or choosing lower-cost options, both of which have an increased risk of poorer outcomes, rather than actually fixing the real problems in our system. I think that is quite revealing about the actual values of the proponents of this plan, regardless of what they claim to be their political values.

As others have already commented here, the structural problems with our current system that force people to make financial decisions that put their health at risk are directly traceable to the fundamental conflict between the profit motive in our system as it is currently constructed and the goal of delivering the proper level and quality of health services to everyone. Single-payer-of-premiums to insurance companies models like this Wyden plan does nothing to address that fundamental conflict. To the contrary, this plan legitimizes the value the risks to our health are fairly traded of for profit. For the unverifiable costs analysis of Sheils' <et al=""> to come to pass, people will need to continually make tradeoffs in their health care.

Furthermore, because lower income people will by design be placed in position of making health care decisions which have bigger ramifications for their economic security, a strong argument can be made they will be forced to take more risks with their health. By the way, Section 123, Subsection (f) provides that if a person has to file bankruptcy any penalty imposed with respect to such person for failure to pay a HAPI plan premium shall not be subject to discharge. That is, if you have to go bankrupt, and under this compulsory plan the insurance company has assessed penalties (which also are not subsidizable incidentally and which presumably will compound) because you haven't paid premiums for whatever reason, you remain indebted to the insurance company until, if ever, you are able to pay. That is a direct consequence of this single-payer-of-premiums to private insurance companies plan. It is also right in line with the regressive right-wing bankruptcy "reforms" being enacted over the last several years.

In contrast to this regressive Wyden plan, a geniunely progressive single-payer-for-services to medical service providers plan like Conyers-Dingall Medicare-For-All addresses this problem directly by explictly giving buying power leverage to the people collectively. Furthermore, by enrolling everyone in that system, they also effectively create a powerful incentive for all of us to work together to continually improve it.

I think Ron owes it to us to make an oral statement in which he squarely addresses these facts and stating his personal values which the media can record and present to the public. Given his arrogant and condescending attack on Medicare for all supporters in the 8:00 hour of the Hartmann show 12/14/2006, it doesn't seem we should be holding our breath for a show of personal integrity like this any time soon.

Has Kitzhaber commented on the legislation? His WeCanDoBetter group seems to have a much broader set of goals concerning delivery.

I would stand with the "politicallogic" in his assessments that a hodge-podge of private insurance plans coordinated with a universal Medicare styled plan is just a diversion from making the decision that should have been made 20 years ago.

We happen to be the laughing stock of the modern democratic world in so many ways since our Republican takeover. The subject that makes them laugh the most is to see our vast medical technology and science research reach amazing heights that our own citizens will never afford, and will likely be another service offered in their universal medical coverage in the near future.

We finance the research, the testing, and the process for cures and treatments across the board and it’s offered at a small percentage of the price just over the border in Canada. We have seniors, medical advocates, and politicians lauding a plan to buy in bulk medicines devised in the U.S. and sold in Canada for a fraction of the price as a remedy to lowering healthcare costs in our own country!! Am I the only one who recognizes the absolute absurdity of this???

Why should we be having such a ridiculous debate on such a ridiculous set of circumstances and not address how we got to this place? How can we correct it? Could it be that somebody of enormous power in our own country is profiting by this perversion?? Maybe the insurance and drug companies could have something to do with this???

Canada was the whipping post for how bad an idea of having a universal payer plan for health care delivery nationwide for the first decade of the plan, I don’t hear that argument much anymore, do you know why??

Could it be that the plan is still sustaining it’s self??

Could it be that Canadians have embraced their plan and worked hard to tweak, change, and correct the plan over the years and as a result made a very effective plan for all Canadians???

Could it be that they see the benefits at all levels of society that has brought Canadians closer together, and made their economy stronger for not being under the thumb of their insurance industry for their health care???

Could it be that bringing up the subject of Canada has been methodically villianized by the corporate media through the billions of drug companies’, and insurance companies’ advertisement dollars to convince Americans of some undefined absurd argument that Canadians aren’t Americans and some how the same principles would not work here??

Wake up Call America, Canada borders our northern border from one coast to the other, and they have competent, affordable, and viable universal healthcare for everyone, and we DON’T.

Happy Thoughts;

Dan Grady

H.R. 676: Expanded and Improved Medicare for All Act is supported by Congressman (and 2008 presidential candidate Dennis Kucinich. Why leave the profit-driven insurance companies in charge of health care when there is a proven better way? I want a real solution, not some compromise to the insurance companies, no baby steps that fail to address what is fundamentally wrong with the current system. Family members have been victims of HMO decision making (once example, my step-dad, a Sears employees, was not authorized to receive the tests that would have diagnosed lung cancer early enough to effectively treat it, he was given cough syrup by the doctors early in his illness though he requested further tests, many months later when those tests were finally authorized and he was diagnosed as having stage-four lung cancer and it was too late, the experimental treatment he received failed and he died late summer in 1997; he and my mother couldn't afford to make additional payments outside of the Sears plan). I'm sure others have their stories of how the system failed them or their families. I am not a health care expert, not even close but it seems that as long as there is a profit motive in health care there is a disincentive to do what is best for the people. Remove the insurance companies from the system. I think Wyden owes us an explanation of why he thinks his plan is superior to HR 676 and why he isn't supporting a senate version of that legislation. Thanks to all who have written advocating for this better way.

Correct link to Dennis Kucinch's statement on universal health care. Sorry about the error.

As a federal retiree under the FEHB system since 1976 I take issue with the notion that the FEHB is a single-payer plan. It is heavily subsidized by the government in that it pays for at least 2/3 of the premium and the employee/retiree's contribution is a before-tax deduction (I think), but the payors are the insurance co. and the patient.

I now pay $95/mo. for Kaiser coverage that includes dental!! Co-pays might amount to $200 in a bad year.

Contrary to the notion that individuals will have to deal with ins. co's, the Wyden plan sets up State agencies to offer citizens a menu of plans that are REGULATED so that they are affordable and available to all regardless of health status. One would hope that the agencies could go further in controlling costs by requiring evidence-based medical practice, prioritization of care a la OHP, electronic records, etc.

Finally, we love the low administrative costs of Medicare, but its cost-control methods are to cut provider reimbursement so that providers refuse to accept Medicare patients and to shift costs onto patients. In 5 years Medicare will start going broke, and by the time the boomers retire Medicare will suffer a $65 TRILLION deficit!! Lesson to learn: health care must be adminstered (prioritized and budgeted) closer to home, i.e., by the States with the financial backing of the Feds. Kudos to Sen. Wyden!

Finally, we love the low administrative costs of Medicare, but its cost-control methods are to cut provider reimbursement so that providers refuse to accept Medicare patients and to shift costs onto patients. In 5 years Medicare will start going broke, and by the time the boomers retire Medicare will suffer a $65 TRILLION deficit!! Lesson to learn: health care must be adminstered (prioritized and budgeted) closer to home, i.e., by the States with the financial backing of the Feds. Kudos to Sen. Wyden!// Bobbi

I would like to believe this argument is sincere. Medicare is in a budget crisis we can agree, though we disagree as to its remedy. A discipline in Congress to restore the Trust Fund, as well as a lifting of the income cap, and a huge infusion of contributions from the younger work force as part of the plan in a universal single payer plan would be more than enough to make it solvent into the future, and self sustaining. This strategy along with a Medicare program that can negotiate as a whole with drug companies and medical providers goes to making the program fair for all involved.

I would like to think that each state would have it’s heart in the right place when administering medical care through a Medicaid style grant program, but; this has proven a “divide and conquer” strategy for the GOP as they seize statewide power of smaller populated western states to deploy their own privatized programs to introduce the same programs nationally so as to erode support for the overall idea of universal payer program.

This path just ends up a path leading to were we started and with less resources and support to implement the solution we should have at the start. The history is unmistakable and we cannot afford to jump on that merry-go-round again and again as we have for the past 30 years.

Happy Thoughts;

Dan Grady

As a federal retiree under the FEHB system since 1976 I take issue with the notion that the FEHB is a single-payer plan. It is heavily subsidized by the government in that it pays for at least 2/3 of the premium and the employee/retiree's contribution is a before-tax deduction (I think), but the payors are the insurance co. and the patient.

Bobbi can take exception all he or she wants, but it simply illustrates that he or she doesn't really understand what he or she is talking about. The explanation of it's basic nature, and why that makes it much more a single-payer in essence has already been provided. The business model, decision-making power, and risks for insurance companies in their effectively administrative role in the FEHB system is very different from that for the products they offer to private businesses and individuals. (Not too mention that most reports seem to indicate that the majority of FEHB insureds choose a particular option from the Blue Cross group of companies.)

Contrary to the notion that individuals will have to deal with ins. co's, the Wyden plan sets up State agencies to offer citizens a menu of plans that are REGULATED so that they are affordable and available to all regardless of health status.

Bobbi is playing word games that here hinge on his or her use of the term REGULATED. Apparently, Bobbi is alluding to Title V: "State Health Help Agencies", referred to as HHAs in the text. The law does not provide that HHAs function as Bobbi implies:

Section 502 (a) PROMOTION OF PREVENTION AND WELLNESS primarily provides that the HHAs are to provide education and information to citizens about their legal obligation to buy insurance from the private companies, and collect statistics about citizen compliance (yes, the title is a misleading misnomer).

Section 502(b) ENROLLMENT OVERSIGHT primarily provides that the HHAs are to function as the administrative clerks and consumer sales force for the private insurance companies by disseminating sales information about the plans, collect enrollment forms, and report stats about compliance to the federal government.

Section 502(c) DETERMINATION AND ADMINISTRATION OF HAPI PLAN SUBSIDIES primarily provides that the HHAs are to administer the federal health insurance premium subsidies for eligible individuals and serve as the collection agent for the private insurance companies for any premiums subsidized individuals may have to pay.

Section 502(d) PREMIUM RATING RULES provides that the HHAs will perform the clerical task of confirming that the plans offered by the private insurance companies in their state meet the general coverage requirements specified in Section 111 of the law. (Curiously, Section 511 makes abortion an extra cost insurance option not available under the minimum plan subsidized individuals are eligible for. Even more curiously, Section 512 specifies Specific Coverage Requirements and the HHAs are not mandated to insure that insurance companies meet those requirements.)

Section 502(e) EMPOWERMENT OF INDIVIDUALS TO MAKE HEALTH CARE DECISIONS directs HHAs to provide information about the rights of individuals to make the most general of health care decisions about end-of-life care - like having your living-will respected. It does not explicitly protect Oregons' Right-to-Die statute by the way.

Section 502(f)-(h) charge HHA with several internal administrative duties.

Section 503 of Title V deals with money appropriations over the transition years to fund the HHAs and what HHAs must do to get those funds.

So despite what Bobbi claims without proof, the actual role of HHAs is not to make sure insurance companies plans are REGULATED so that they are affordable and available to all regardless of health status. In fact, the only meaningful regulation they do is to participate in making sure we have made our compulsory insurance premium payments and in actually collection those monies from subsidized individuals to make sure it gets to the private insurance companies.

This is quite in keeping with the explicit intent of the plan stated on page 13 of the Sheils' et al report noted earlier:

The program includes features designed to make people more aware of their spending for health care and to create incentives for consumers to seek-out lower-cost health coverage. One of these features is that employer spending for health benefits converted to wages so that the worker faces the full cost of health insurance. This would give families the opportunity to retain some of this cash for other purposes by purchasing a less costly health plan. Also, families must pay the full amount of the added cost of selecting a higher cost health plan as further incentive to conserve on spending.

Even more importantly, we see in Title V that the HHAs are the mechanism by which the Federal government gets out of any role of using the collective buying power of us all to negotiate favorable rates. At the same time, Title V does not devolve corresponding authority and power to the HHAs. Wyden's plan quite fairly can be argued to be the biggest corporate welfare plan, at the cost of risking everyone's health and economic security, of all time.

The closer we look at Wyden's plan, the more we see just how bad it is. What is more disappointing is the amount of deceit is involved and how uniformed some of the most ardent supporters are.

All this blogging when it can be summed up with one word: Lame.

Politcallogic, you respond to...

The program includes features designed to make people more aware of their spending for health care and to create incentives for consumers to seek-out lower-cost health coverage. One of these features is that employer spending for health benefits converted to wages so that the worker faces the full cost of health insurance. This would give families the opportunity to retain some of this cash for other purposes by purchasing a less costly health plan. Also, families must pay the full amount of the added cost of selecting a higher cost health plan as further incentive to conserve on spending.

by saying this..

This is almost exactly what all those regressive right-wingers who don't believe equitable and accessible health care should be a right have been advocating ever since the first attempt at fixing our health care system in the 1990s. That is, the goal is to get people to make decisions about foregoing health care, or choosing lower-cost options, both of which have an increased risk of poorer outcomes, rather than actually fixing the real problems in our system. I think that is quite revealing about the actual values of the proponents of this plan, regardless of what they claim to be their political values.

You have confused two concepts: 1) having consumers face the full cost of health coverage 2) having consumers face the full cost of health expenses

There is a big difference between having to pay the full cost of your health insurance premium every month ($500 max) and potentially having to face the full cost of a liver transplant ($300,000). The second one is what right-wingers want to do and is not what is being proposed. There is also a massive redistribution built into the proposal to make it affordable for low and low middle income people. You may be right that it preserves the insurance industry, but it is no right-wing agenda.

Of course, Peter Gaven is wrong in his unfounded belief that I am confusing two concepts.

What all the right-wingers I known believe is precisely what I highlight in the material from this now discredited PR piece by Sheils et al: That the only way to reform health care is to make people more aware of their spending for health care and to create incentives for consumers to seek-out lower-cost health coverage. That is, rather than having a single-payer plan in which we use our collective buying power to control healthcare costs, we should control costs by reducing demand for healthcare. In practical terms, this is to be achieved by forcing us to make financial tradeoffs in our health care decisions regardless of the fact that this will negatively impact the health most of those with fewer resources.

Furthermore, although I have no desire to defend right-wingers, no sane right-winger takes the ludicrous and extreme position Peter Gaven claims they do. All of the right-wingers I know, and some of them are pretty nutty, believe that forcing you to put a price on your health, determined by what you can afford, is the right thing to do. They believe the way to do that is to force everyone to buy insurance from private insurers and to have to tradeoff benefits and specific coverages based on what you can afford. Just as Wyden explicitly says is his specific intent.

The right wing gave us Medicare Part D. That plan forces those who decide they want a medical benefit - in this case prescription drug benefits - to buy it from private insurers. It gets the government out of the business of using our collective buying power to negotiate favorable rates and coverages to the financial benefit of those private coroprations. The sponsors explicitly intended that people have to make tradeoffs as to what plan they will buy based on what they feel their medical needs are and their available resources. If people guess wrong they are in the extremely difficult position trying to find an alternative just at a time when they should be concentrating on their health.

This happens to also describe many of the essential properties of Wyden's plan. If you like Medicare Part D, you'll love Wyden's plan even more because he will force you to buy on the insurance companies' terms.

So no, Peter Graven, I wasn't confusing anything. Tragically, it is you and all the supporters of Wyden's right-of-center plan that are intellectually and morally confused.

I think it is striking how in this very thread the arguments made by supporters are not head-to-head debates about political values, since to have that kind of principled debate over Wyden's plan they would have to defend a right-wing position. Instead, the supporters argue by either not representing the actual aspects of the plan accurately, or by incorrectly representing the positions of opponents. I am really starting to wonder what that says about Wyden. I think the question he should be made to answer publicly by the press is whether he will support a single-payer plan like Conyers-Dingell's Medicare-For-All plan if his plan fails.

Just to be clear, the last sentence of the last post should read:

I think the question he should be made to answer publicly by the press is whether he will support a single-payer plan like Conyers-Dingell's Medicare-For-All plan if his plan fails to pass.

Yes, they both have sponsored a bill in the last Congress. And the term Medicare-For-All refers to them both, as you can see in the title's to both bills:

H.R.676 (Conyers) United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act) (Introduced in House)

HR.4683 (Dingell) Medicare for All Act (Introduced in House)

It also refers to the concept all at once as in these editorials:

Medicare-for-All is the prescription for taming health care costs, says insurance expert http://news-info.wustl.edu/news/page/normal/4981.html

A Democratic Blueprint for America's Future Senator Ted Kennedy http://www.commondreams.org/views05/0112-37.htm

I call this approach Medicare for All, because it will free all Americans from the fear of crippling medical expenses and enable them to seek the best possible care when illness strikes.

Medicare for All http://www.thenation.com/doc/20060206/stark

Kari also comments:

So, they've actually got competing plans.

I'm not sure of the point. It is a fair and accurate observation they have introduced different plans that would/should receive consideration in their own right.

You'd need to make an argument demonstrating they are competing plans in any meaningful sense of the word in view of the above, and the fact they have been discussed here in the sense of a true progressive Democratic approach that is rooted in a very different set of political values from Wyden's regressive, right-of-center plan for compulsory purchasing of private insurance.

This point was further illustrated at the end of my last post. I am persuaded that Conyers and Dingell would come to support the same plan "Medicare For All" plan. The important distinction, that I wish the media would put Wyden on the spot on tape to resolve, is whether he (Wyden) will support a single-payer plan like Conyers-Dingell's Medicare-For-All plan if his plan fails to pass.. I suppose for accuracy this should have read Conyers'/Dingell's Medicare-For-All plans. So noted and re-submitted to the press and public.

I'm listening to Hartmann's discussion with Kari as I type this. It really was a very unenlightened conversation that did nothing to elucidate and resolve the fundamental conflict of values between Wyden's plan and Medicare-For-All plans. Hartmann followed up with the director of Oregonians For Health Security and in that conversation both admitted neither had read Wyden's bill. They then went on to muddle through an inaccurate discussion of the bill that both gave support to his plan, but then criticized it's fundamental premise of compulsory purchasing of private insurance. It seemed that the most important thing about both was ego gratification that it was Oregon and Oregonians "leading the way", even if to the rest of the country this looks like anything but that.

To both Kari and Hartmann I answer their assertion that true progressives shouldn't be fighting amongst themselves this way: They are right. The insurance industry knows Wyden's plan is a sweet deal for them. They will put up a charade of opposition, but that will only be to mislead the naive, give cover to the faux progressives, and get more concessions in any final bill. Wyden has proven he has little competence to push his own legislative priorities in his years as a Senator. Rather than signing up to work for the insurance industry as he does with his plan, he should do the decent and principled thing by not introducing his bill and sign on to do the grassroots work of getting a Medicare-For-All plan passed.

speaking of sponsors - why are we referring to this as Wyden's plan, when he should share the credit for it with Orrin Hatch? Hatch has been fairly low-profile recently, but his cosponsorship explains a lot.

Politcallogic,

I have to hand it to you. If people really believe you that this plan is right of center, all the more power to you.

The conversation ended with Kari telling Thom Hartmann that the opportunity to offer all Americans affordable health coverage is enough of a reason to stand behind this effort.

I would strongly disagree!! If we are to beleive the electorate is prepared for a solution, then it should be our best effort out front, and like the Republicans we can hold this in reserve as an compromise solution, or a fall back. This way the Republican can herald a victory in their defeat, and we can have our healthcare coverage.

I stress that politically we should not compromise on this issue if it's a solution we really want. A Medicare/Champus universal healthcare system is 30 years overdue and sorely, if not despartely needed!!! I believe the vast number of people whom face this issue, and vote believe so too. If we stand with the idea it will prove us right, and make arguments to erode it mute to the pragmatic need of sustaining it.

What Peter Graven doesn't understand is the difference between belief and at least as close as we can get to fact demonstrated through argumentation. I've presented the arguments why the Wyden-Hatch plan is right-of-center, so this really has little to do with belief.

Rising health care costs. That is the ultimate question for this plan. How much monopsonistic buying power does society need to overcome any monopolistic selling power the insurers have? If costs keep going up every year then additional legislation would be necessary to counteract it. Will it be possible to pass those modifications with an insurance lobby? Maybe not. But, in the meantime, we have universal coverage.

The Dingell/Kennedy "Medicare For All" bill does use private ins. co's as does Wyden's bill ("as good as your Congressman gets"). It also comes with a 7% payroll tax for employers, whereas Wyden's has an employer "contribution", which seems more graduated.

As for Wyden's plan being a sweet deal for ins. co's: their cherry-picking days will be over when they will be forced to cover the chronically ill and those with pre-existing conditions, reducing much of their profitability. You might recall that OHP involved Blue Cross at first, but they dropped out because they could not make money . Care Oregon was set up to administer the plan.

Bobbi once again is off-the mark.

The Dingell/Kennedy "Medicare For All" bill does use private ins. co's

The Kennedy-Dingell plan does allow private insurers to offer plans and allows people to elect partipate in them if they choose. The core of H.R. 4683, however, is that it makes every individual eligible to participate in an expanded Medicare plan paid for through payroll deductions and employer matches. That is a single-payer for medical services plan in which our collective buying power is leveraged to control healthcare costs.

This completely different from Wyden's plan for universal compulsory purchasing of health insurance from private insurers.

As for Wyden's plan being a sweet deal for ins. co's: their cherry-picking days will be over when they will be forced to cover the chronically ill and those with pre-existing conditions, reducing much of their profitability.

Wrong again. They will more than make up in numbers, and the security of compulsory purchasing what Bobbi believes they will loose. Under that extremely stable market and demand model, and with no restrictions on pricing other than what individuals can exert as they trade off their economic security for their health, the insurance companies can adjust premiums accordingly to insure profitability.

As I said before, it is instructive that although the defenders of the Wyden plan are tragically misinformed, they are not at all shy in demonstrating that fact.

PL -- Could you identify for me how many Senators have publicly stated their support for a single-payer program? And then, if you're really ambitious, attempt a rank-ordering of the next best likely prospects to support such a program?

Frankly, just because a number of Senators like Wyden don't have the brains or leadership ability to do anything except prostitute themselves to the insurance industry is no reason to join them. It certainly is no reason to respect them or to give any credibility to ANY legislation they offer.

Why don't you and the group who run the StandTallForAmerica.com website (that's a dishonest name if I ever heard one as Wyden grovels before the insurance industry) get Wyden to tell us if he will support a single-payer plan like Conyers'/Dingell's Medicare-For-All plans if his plan fails to pass. I think we need to hear the answer to that before we give his sell-out plan any consideration at all.

Let's not let the perfect be the enemy of the good, universal, affordable, comprehensive, portable, and nondiscriminatory.

As has been well argued here, it has already reached the point that supporters of the Wyden plan have nothing to offer but this kind of juvenile, propogandistic sloganeering. The Wyden plan is not even close to what you describe. As has already been noted, the financial projections for the success of the plan by Sheils' et al are based on assumptions that are not backed by any language in the actual legislation and derived from a purported model which has not been offered for public examination. The plan itself is predicated on making people tradeoff their financial security for their health to control costs. Finally, it embodies the worst kind of discrimination in that it devalues people with fewer resources because this type of tradeoff falls hardest on them.

If you really believe a plan which compels us to all buy insurance from private insurers and leaves all important decisions about contracting for health care services in the hands of private insurers will provide good, universal, affordable, etc. health care you are far more foolish than I ever thought.

This little bit of foolishness deserves a response of its own:

Can you count to 51?

As we know there were plenty more than 51 easy votes to get us involved in Iraq, so this kind of political wisdom about finding 51 easy votes is about anything but true leadership.

On something as important as our health, our job is to scare enough Senators that they will lose re-election if they don't support a single-payer Medicare-For-All plan into joining those who already do to reach 51+ votes.

A good place to start is with older folks who already vote at a higher rate and in larger numbers than younger folks. Those of us who are true progressives and not easily duped into selling out need to remind those folks that their Medicare coverage will only get better if more people join the program. Making more people eligible for Medicare would help control health care costs through increased collective buying power and give more people a vested interest in improving the quality of the program.

Judging from the demographics of the last election and this discussion, we can also gain quite a few votes by pointing out we are depending on them to make their voices heard because the following generations aren't yet wise enough to know better.

I can count way over 50 votes if we do that.

One thing to consider about medicare is that it is going broke down the line (despite its market power). We have not shown the responsibility in this country to raise our taxes to pay for it. As one on the young people that will have to pick up the tab for the unfunded promises, that is a concern for me. I mean, if you think it would be hard to get 51 votes for promising medicare-for-all benefits, think about how hard it would be to get 51 votes to raise our taxes to pay for it. So far, we have consistently done one without the other in this country and it is a recipe for disaster.

On the wave of a progressive victory that re-took both houses even though a marginal majority in the Senate. I would contend this is the time to put forth the fight for a Medicare/Champus universal plan which has the strongest argument because of it's history reliable healthcare delivery, and it’s familiarity with the electorate like SSI!!

I believe that in many cases the American electorate is way ahead of the representation on this point, and a looming election in '08 will make Republicans in the Senate very pliable this time next year. I predict that the coming elections in '08 will ring a louder call to the progressives, and will yield a much greater majority in both houses, and likely a Democratic President.

If you handicap it the way I do, then making the play for universal healthcare now gives us a stronger hand in the coming next election either way!! I say the Bush Administration has put to death the Neo-Conservative Era, and rung in a New Progressive Movement that plays to the center of the political spectrum. I say when you’re holding the “Nuts” and their betting in front of you, it’s a good time to “Check and Raise” baby !!!

Happy Thoughts;

Dan Grady

To the extent that Peter Graven argues that the Wyden plan is financially feasible, he provides the basis by which his argument that One thing to consider about medicare is that it is going broke down the line (despite its market power).

Under the Wyden plan to require people to buy from private insurers, the actual dollars for the government to turn over to private insurers will be gathered by a payroll deduction. Those funds could instead be used for a Medicare-For-All plan and the same level of services can be delivered with a smaller payroll deduction due to market buying power.

Furthermore, Medicare is not going broke because of a failure of a market buying power. It is going broke because it is not a universal plan and there are demographic shifts taking place that a Medicare-For-All plan would correct. The solution of the Wyden plan to this problem is to compell people to make tradeoffs between their financial security and their health, a tradeoff which falls hardest on those with fewer resources.

Since your argument doesn't hold water Peter Graven, I think you should address the real issue here, which is why you advocate forcing people to buy insurance from private insurers to the profit of those private insurers, rather than have us all contribute to and participate in a Medicare-For-All plan which we all control and would have a joint interest in making better and better. I think you should tell us if you support Medicare Part D that is based on the same general political values that the way to control healthcare costs is forcing individuals to trade-off financial security versus health as the Wyden's plan does, and what you think of Medicare Parts A and B that are based on general principles of equity and shared responsibilities for health care as Medicare-For-All would be.

Someone who is truly wise about health care said,

But I have come to believe that universal coverage by itself will not solve our health care crisis. For example, everyone over the age of 65 is already covered by the Medicare program, yet the result of this universal coverage is an unfunded entitlement in excess of $65 trillion that casts a dark shadow over our nation’s fiscal future. John Kitzhaber http://www.archimedesmovement.org/node/87

I found this report and it seemed to me that there was no way that we could get anywhere close to the savings these other countries get, as well as their outcomes, without drastic changes and not just assuring universal health care and hoping that costs would come down.

I wonder, what Sen. Wyden would have said to FDR when Social Security was proposed. That we couldn't do that much that fast? That we had to bring Wall Street brokers into the mix to make sure that they still received their commissions?

While I acknowledge that single payer is far far different than the current system and may seem unattainable, I also wonder what would happen if there was the political will to settle for nothing less. At the very least, why are progressives presenting a plan that the insurance companies should be presenting as THEIR compromise.

I should mention that kitzhaber's previous quote was in regards to his criticism of the Massachusetts plan which has many similar features to wyden's plan. So I agree with PL that there is something better than wyden but i susupect it will address delivery issues and will be even more diffiult politically. But Kitzhaber is the Oregonian to watch for health care in my mind. That's it for me. The water cooler is empty.

Kari; am I to understand that this is not politics?? Elections and their consequence is the biggest weapon in the arsenal for both sides. We have the biggest gun, and the opposition is unconvinced. I say that we allow them to embolden themselves with the idea that America doesn’t want a Medicare Universal Healthcare Plan and as the details unfold, and the reality comes into focus, let them continue on that course at their own peril, or jump on board, either way the plan gets to the President’s desk!!

Maybe with the growing possibility of an impeachment after months of oversight hearings, and the undoubtedly horrors to be revealed he’ll be more pliable!! We all know he’ll veto Wyden’s bill in any form, so why not make the bold play, and take a chance to make them play!!

I have no qualms about this tactic whatsoever, why should I? To give quarter to the opposition who has already repeatedly proven they’ll never return the favor, or repent for that matter, why?! It’s not as though we’re doing anything wrong!!

He laughed out loud and said, "If you think the insurance companies are going to hold a rally for my bill..." He trailed off, because the answer was completely obvious. The insurance industry will be organized AGAINST his proposal. They make their money from medical underwriting ("cherrypicking") and this plan outlaws that.

To which I'll repeat what I've already said. The cherry-picking as a reason to support Wyden's plan argument is false. As I have already noted:

(The insurance industry) will more than make up in numbers, and the security of compulsory purchasing what (you) believe they will loose. Under that extremely stable market and forced demand model, and with no restrictions on pricing other than what individuals can exert as they are forced to trade off their economic security for their health, the insurance companies can adjust premiums accordingly to insure profitability.

Furthermore, as I have also already commented,

(The insurance industry) will put up a charade of opposition, but that will only be to mislead the naive, give cover to the faux progressives, and get more concessions in any final bill.

Just repeating the cherry-picking argument doesn't make it any more true. However, it is a time-honored propoganda technique of unprincipled politicians. Tell Sheils' et al to put the numbers on the table and the model used to derive them that shows insurance industry profits will actually decline under the Wyden plan and you may have a defensible position.

I really don't want to believe Wyden is so unprincipled that he would dupe his supporters with this cherrypicking argument to defend selling us out to the insurance companies in this way. Based on what the supporters of his plan have argued in this thread, the alternatives are hardly more flattering.

"If you think the insurance companies are going to hold a rally for my bill..." He trailed off, because the answer was completely obvious. The insurance industry will be organized AGAINST his proposal. They make their money from medical underwriting ("cherrypicking") and this plan outlaws that. // KARI

Answer me this my honorable webmaster/political operative!

Do you believe that the opposition to Wyden's shared FEH plan will get a much greater than, less than or equal fight from the insurance lobby than it would give to a Universal Medicare Single Payer Plan?

Do you think Congressional Rep's & Senator's would be more concerned with a popular progressive movement at the ballot box, or loosing an insurance lobby's endorsement and financial aid to their campaigns??

I do not ask this as a rhetorical question as I really don't know the answer!! I do believe that next year we will be in a fire storm of outrage from an electorate enlightened to the real extent of Republican corruption, incompetence, and the corporate influence in our government.

6 years without OVERSIGHT!!! Think of it, Kari, think of the opportunity to grab the nation's attention and direct it to its own best interest!! Think of the opportunity the Democrats have to get America really engaged in its government & political process!!

Am I alone? Do you not feel the change in the body politic? Am I the only one who sees the dull look that was once the nodding head of approval when listening to the Neo-Con & Republican rhetoric?? Am I alone in believing the curtain has been drawn to reveal the real wizard for what he really is??? A tired, frustrated, greedy, and angry cowardly old man!

Happy Thoughts;

Dan Grady

I humbly request the attentions of Kari Chisolm relating to my question posted above!

Thank you very much;

Dan Grady

Sooo A Single Parent making 7.25 an hour would gross 290 for a 40 hour week. An estimated 153 dollar HMO payment would be taken off the Top. In exchange for an end of year Tax Credit? Would the Tax Credit result in an %7,956 income tax refund? Would a person in that situation be able to afford a copay for anything other then an office visit?

This plan is nothing more then a scheme to assure HMO' profits! And yes the Insurance will be beyond happy over this plan. How The He** do you mandate people buy from groups that have raised rates 75% in 5 years. Without a single one of those years being unprofitable!

Please DR Mccane's comments on the "Healthy Americans Act " Its flaws and Rhetoric.

http://www.pnhp.org/news/2006/december/lewin_group_analysis.php

[quote]Wyden’s plan falls apart since it depends on price competition of health plans, which in turn depends on shifting more unaffordable costs directly to those who need care.[/quote]

I have read the Lewin group report and the plan detail pdf. their is no subsidy. It is a line deduction on the tax return. The Scenario I demonstrated with the Single Parent is how it works. The HMO premium is withheld from the paycheck.

"Section 664: Health Care Standard Deduction: Creates a new Health Care Standard Deduction. Taxpayers can claim this deduction and reduce the amount they pay in taxes whether they file an itemized tax return or take the standard deduction. The amount of the deduction a taxpayer can claim depends on the class of health care coverage the taxpayer has. The deduction is indexed to the consumer price index with the deduction amounts initially set as follows: Individual coverage - $6,025 Married couple or domestic partnership coverage - $12,050 Unmarried individual with dependent children - $8, 610 plus $2,000 for each dependent child Married couple or domestic partnership (as determined by a State) with dependent children - $15,210 plus $2,000 for each dependent child The deduction can be claimed by individuals and families with incomes greater than the poverty line. Both the health care and the healthy child deduction are phased in starting from 100-400 percent of poverty. The deduction begins phasing out starting at $62,500 ($125,000 in the case of a joint return) and is fully phased out at $125,000 ($250,000 in the case of a joint return). The deduction will be adjusted for inflation"

Will that Tax deduction make up for the week to week hardship. NO!

This plan has to be rejected out right. It is For Business and Insurance By Business and insurance!

I have read the Lewin reort. Figure Ten is Hooey. Change in premium payments is if they already it. If they did'nt have it It's a 7,000 dollar increase in exchange for an additional 500 in the tax refund?

Lewin also talks out of both sides of its mouth. At one point it says this plan insulates business from Double digit rate inflation.

While at the same time claiming competition will lower rates.

We have seen in the last five years there is no competition. Only Collusion. 75% rate increases over the last 5 years.

And Fundamentally in a universal healthcare system. HMO's are unneccesary. It is immoral to mandate the subjugation of the people to the profit mongering of HMO's!